Emergency: requires immediate attention
Giant cell arteritis
Alerts and Notices
Synopsis
Patients may present with systemic symptoms such as new headache, anorexia, weight loss, neck pain, myalgia, fatigue, and anemia. There may be elevated erythrocyte sedimentation rate, temporal artery tenderness to palpation, or decreased arterial pulsation unrelated to arteriosclerosis. Patients may have scalp tenderness, visual disturbances, jaw claudication or difficulty chewing, or upper cranial palsies.
GCA and polymyalgia rheumatica (PMR) have a significant clinical association: 16%-21% of cases of PMR are associated with GCA, and 40%-60% of patients diagnosed with GCA also have PMR.
The most serious complication of GCA is blindness, a result of anterior ischemic optic neuropathy caused by ischemia secondary to inflammation of the ophthalmic artery supplying the optic nerve. Some patients may experience transient vision loss. All patients with suspected GCA should have temporal artery biopsy. Pathologic findings include a predominance of mononuclear cell infiltration or granulomatous inflammation, usually with multinucleated giant cells.
Scalp necrosis is a rare but potentially life-threatening complication.
Codes
ICD10CM:M31.6 – Other giant cell arteritis
SNOMEDCT:
230732009 – Cerebral arteritis in giant cell arteritis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Aortic dissection
- Takayasu arteritis
- Kawasaki disease
- Carotid stenosis
- Cerebrovascular disease
- Arteriovenous fistula
- Intracranial neoplasm
- Sepsis
- Acute angle-closure glaucoma
- Granulomatosis with polyangiitis
- Iritis / uveitis
- Migraine headaches
- PMR
- Retinal artery occlusion (branch, central)
- Retinal vein occlusion (branch, central)
- Rheumatoid arthritis
- Polyarteritis nodosa
- Amyloidosis
- VEXAS syndrome
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:02/25/2019
Last Updated:01/11/2022
Last Updated:01/11/2022
Emergency: requires immediate attention
Giant cell arteritis